ADHERENCE IMPROVEMENT MODEL BASED ON KING INTERACTION SYSTEM

BACKGROUND Indonesia is the fouth largest contributor to tuberculosis (TB) in the world in 2012, the number of new cases of approximately 400,000–500,000 cases, after India (2.0 million-2.5 million), China (900,000–1,100,000) and South Africa (400,000–600,000) cases (WHO, 2012). According to Riset kesehatan nasional or National Health Study in 2001, the pulmonary TB is the number one desease and as the third cause of death in Indonesia (Depkes, 2001). Based on data from TB Sub Directorate of the Ministry of Health Republic of Indonesia and WHO (2008) that until January 2007, 37% of hospitals implement DOTS with the different quality. TB average ranks number 2 in the outpatient clinic at the General Hospital and rank number 1 in Lung Hospital. Nearly 6.5% of the cases the treatments of category II who failed treatment and showed MDR-TB (multidrug resistant TB) are found in hospitals. Various attempts have been made by the government to address TB among TB control is a global plan aimed at achieving global targets in line with the WHO TB DOTS (directly observed treatment, short-course) and a new stop TB strategy. According to Ministry of Health Republic of Indonesia in 2008 TB prevalence was 253 per 100,000 population while the MDGs (Millennium Development Goals) targets in 2015 for TB is 222 per 100,000 population means that it is the conditions in Indonesia closer to the expected target. In 2009 to reach 71% case detection and treatment success rate reached 90% (Kemkes, 2011). Nurses has important role in facilitating therapy and shaping constructive behavior to patients with TB thus they were motivated to become adhere to treatment. Current discrepancy in TB treatment includes health education was held by nurses was less optimal at nurse-patient interaction to improve patients’ adherence. The participation of nurses in government programs is indispensable in order to avoid treatment failure which led to the MDR-TB or XDR-TB. In addition to supporting the government’s program, one of which is the program PMO, nurses need to perform an approach to patients in performing the adherence of treatment. Based on the fact mentioned above, a new approach focused on nurse-patient interaction system is needed. King’s Interaction System Model can be used to improve nurse-patient interaction thus the patients’ adherence to treatment improved. Framework dynamic interaction system of King used as a theoretical framework in developing adherence improvemnet model that focuses on the dynamic interaction of personal systems, interpersonal system and social system in achieving the goal of increased pulmonary TB patient adherence. Personal system according to King describes the characteristics of the individual and the individual is seen as an open system (Alligood & Tomey, 2006)

ADHERENCE IMPROVEMENT MODEL BASED ON KING INTERACTION SYSTEM

Abstract BACKGROUND Indonesia is the fouth largest contributor to tuberculosis (TB) in the world in 2012, the number of new cases of approximately 400,000–500,000 cases, after India (2.0 million-2.5 million), China (900,000–1,100,000) and South Africa (400,000–600,000) cases (WHO, 2012). According to Riset kesehatan nasional or National Health Study in 2001, the pulmonary TB is the number one desease and as the third cause of death in Indonesia (Depkes, 2001). Based on data from TB Sub Directorate of the Ministry of Health Republic of Indonesia and WHO (2008) that until January 2007, 37% of hospitals implement DOTS with the different quality. TB average ranks number 2 in the outpatient clinic at the General Hospital and rank number 1 in Lung Hospital. Nearly 6.5% of the cases the treatments of category II who failed treatment and showed MDR-TB (multidrug resistant TB) are found in hospitals. Various attempts have been made by the government to address TB among TB control is a global plan aimed at achieving global targets in line with the WHO TB DOTS (directly observed treatment, short-course) and a new stop TB strategy. According to Ministry of Health Republic of Indonesia in 2008 TB prevalence was 253 per 100,000 population while the MDGs (Millennium Development Goals) targets in 2015 for TB is 222 per 100,000 population means that it is the conditions in Indonesia closer to the expected target. In 2009 to reach 71% case detection and treatment success rate reached 90% (Kemkes, 2011). Nurses has important role in facilitating therapy and shaping constructive behavior to patients with TB thus they were motivated to become adhere to treatment. Current discrepancy in TB treatment includes health education was held by nurses was less optimal at nurse-patient interaction to improve patients’ adherence. The participation of nurses in government programs is indispensable in order to avoid treatment failure which led to the MDR-TB or XDR-TB. In addition to supporting the government’s program, one of which is the program PMO, nurses need to perform an approach to patients in performing the adherence of treatment. Based on the fact mentioned above, a new approach focused on nurse-patient interaction system is needed. King’s Interaction System Model can be used to improve nurse-patient interaction thus the patients’ adherence to treatment improved. Framework dynamic interaction system of King used as a theoretical framework in developing adherence improvemnet model that focuses on the dynamic interaction of personal systems, interpersonal system and social system in achieving the goal of increased pulmonary TB patient adherence. Personal system according to King describes the characteristics of the individual and the individual is seen as an open system (Alligood & Tomey, 2006)

MANFAAT SENAM LANSIA TERHADAP KADAR IMUNOGLOBULIN G (IgG)

The health problem is frequently found for elderly with age more than 55 years old. It has adverse effect on cardiovascular and Immunological system. The objective of this study was to analyze the effect of elderly exercise on the increase of fitness in Elderly. The design of this study was quasy experiment design involving two groups subject. The study took 12 respondents of elderly recruited by purposive sampling. The independent variable was elderly exercise and the dependent variable was IgG. Data were collected by laboratory test and analyzed by using t-test with significance level of a ≤ 0.05. Result showed that elderly exercise had significant effect on the IgG level (p = 0,002). Further studies are recommended on the effect of elderly exercise on the increase immunity system concerning with the role of interferon gamma

Motivational Interviewing as a Problem Solving Intervention to Improve Adherence: Review of the Related Literature

Patient behavior changing through adherence therapy is very difficult. Identifying the most effective approach is very important regarding adherence. Motivational Interviewing (MI) is a clinical approach involving communication, collaboration, evocation, autonomy and increasing motivation alongside the final results of behavior change. The principles underlying MI include empathy, developing differences, avoiding debate and supporting self-efficacy. MI interventions allow for the changing of the relevant cognitions and self-regulation processes that leads to adherence to the treatment. Method: A literature review was conducted focused on journals published between 2013 and 2018. Fifty relevant journals were obtained and data was extracted from 25 relevant selected journals. The search was carried out by entering the keywords ‘adherence’, ‘motivation’ and ‘MI’ into the SCOPUS, ScienceDirect, Sage, ProQuest, Elsevier, SpringerLink and Google Scholar databases. Conclusion: MI studies show that MI-based interventions are effective in promoting health behavior changes. It is also associated with positive health outcomes such as low blood pressure, diet, decreased smoking, lower cholesterol, and better blood sugar control. Keywords: adherence, motivation, M

Pengaruh Pelatihan Sepuluh Faktor Carative Caring Terhadap Perilaku Caring Dan Motivasi Perawat (Di Instlasi Rawat Inap Rumah Sakit Islam Surabaya

Sepuluh faktor carative yang diperkenalkan Watson sebagai panduan inti dari praktek keperawatan. Ketidak tahuan perawat tentang perilaku caring yang benar dapat berpengaruh terhadap motivasi perawat dalam menerapkan perilaku caring . Tujuan penelitian ini untuk mengetahui pengaruh pelatihan sepuluh faktor carati ve terhadap perilaku caring dan motivasi perawat di ruang rawat inap Rumah Sakit Islam Surabaya. Desain penelitian ini menggunakan quasy experiment , dengan metode pre post test control group design . Populasi adalah seluruh perawat bertugas di ruang rawat inap di Rumah Sakit Islam Surabaya sebesar 36 perawat , dibagimenjadiduakelompokyaitu 18 kelompokintervensidan 18 kelompokkontrol dengan pengambilan sampel menggunakan total sampling. Instrumen penel itian penerapan caring perawat menggunakan lembar observasi dan kuisioner untuk mengukur motivasi perawat. Data dianalisis dengan menggunakan paired t - test dan independent t - test dengan nilai α = 0,05. Hasil penelitian menunjukkan bahwa pelatihan sepuluh faktor carative caring berpengaruh terhadap perilaku caring(p = 0,000) dan motivasi perawat di Inslasi Rawat Inap Rumah Sakit Islam Surabaya dengan nilai ( p = 0,000) Kesimpulan dari penelitian ini adalah ada pengaruh pelatihan sepul uh faktor carative caring terhadap perilaku caring dan motivasi perawat di Instalasi Rawat Inap Rumah Sakit Islam Surabaya. Hasil yang diharapkan pelatihan sepuluh faktor carative caring dilaksanakan secara rutin, update keilmuan caring dan monitoring pene rapan perilaku caring perawat. Dengan pelatihan ini berupaya meningkatkan motivasi perawat secara timwork

Quality of Nursing Worklife Based on Caring Model for Improving Nurse Performance in Hospitals

Introduction: Nurses performance is still not optimal. The aim this study was to develop a quality of nursing work life to improve nurse performance by integrating Swanson's theory of caring. Methods: An explanative observational design was used with cross-sectional approach. The sample was nurses in inpatient care, intensive care, surgical installations, neonates, hemodialysis from eight hospitals in East Java. The sample size of 430 respondents used total sampling. The variables included QNWL, individual, social and environmental, administrative factors, nurse performance. Data were collected using Nurse Quality of Communication with Patient Questionnaire (NQCPQ), Questionnaire of Personal and Organizational Values Congruence for Employee (Q-POVC), Questionnaire of Brooks & Anderson's quality of nursing work life. The data analysis used Partial Least Square. Results: Twenty-five indicators were declared valid (outer loading value> 0.5) with variable diversity was 24.43%, so that internal, social and environmental, operational and administrative factors affect the performance of nurses directly or indirectly through caring based on QNWL. Predictive relevance value was >0, which indicates that the model was  good enough. The individual factors (p= 0.043; T-Statistics= 2.040), social and environment factors (p= 0.025; T= 2.242), administrative factors (p= 0.001; T= 3.438) have significant influence QNWL based on caring and QNWL based on caring had a significant influence on nurse performance (p= 0.000; T= 4.997). Conclusion: The development of the QNWL model based on caring has good effect in improving nurse performance. From the developed model, nurse performance related to individual factors, social and environmental factors, administrative factors

Effect of Pursed Lips Breathing and Distract Auditory Stimuli Against Dyspnea

Dyspnea in patients with Chronic Obstructive Pulmonary Disease (COPD) is often interpreted as an uncomfortable condition due to breathing difficulties, not only the sensation of subjectivity, but also as a serious respiratory symptom. Pursed lips Breathing (PLB) is a widely used therapy in lung rehabilitation during daily activity in COPD patients, besides this therapy technique has benefits by reducing symptoms and improving quality of life. To reduce the uncomfortable condition due to difficulty breathing and sensation of subjectivity in COPD patients can be done with auditory stimuli using Distractive Auditory Stimuli (DAS), DAS is a non-pharmacological therapy that can be used. to reduce the sensation of dyspnea in patients with COPD. Methods: This research uses quasi experiment type research with pretest approach - posttest with control group design. Patients of COPD who become respondents are divided into 2 groups, group 1 is given PLB and DAS, group 2 is given PLB. Result: The result of this study shows the comparison of pre test for PLB and DAS group has mean and SD (3,19 and 0,75), whereas in PLB group have mean and SD (2,81 and 0,83) with significance level 0,01 (p> 0,05). Comparison of Post test for PLB and DAS group has mean and SD (2,44 and 0,89) meanwhile SD and PLB (2,31 and 0,94) with significance level 0,03 ( p> 0.05). Conclusion: It can be concluded that between PLB and DAS therapy compared to PLB alone have a significant differenc